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Hip replacement for hip socket fractures- role for short stem hip replacement in India


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Hip socket fractures are common injuries in the young active population. They result from four/ two wheeler accidents. The timely treatment is fracture fixation. Often this treatment fails when a hip replacement becomes necessary. This presentation outlines the role for an alternative to hip replacement for this condition

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Hip replacement for hip socket fractures- role for short stem hip replacement in India

  1. 1. Abstract number 226 E Poster –AP03 Dr. A.K.VenkatachalamDr.A.K.VenkatachalamMS Orth, DNB Orth, FRCS, M.Ch OrthConsultant OrthopedicsurgeonAssociate professorChennai
  2. 2. • Acetabular fractures occur in young patients• THR requires acetabular reconstruction, bone graftingand reconstruction• Limb length discrepancy needs to be addressed-due toproximal femoral migration, protrusio, proximal femoralbone loss• Possible to correct LLD on acetabular side with protrusioalone by auto graft, allograft, synthetic bone substitutes,metal• Hence opportunity to preserve bone on femoral side• Hence role for short stem femoral prostheses instead ofTHR.Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
  3. 3. • Case1-25 year male, longstanding mal-united acetabular fracturewith protrusio grade 3. Femoral side normal.• Acetabular reconstruction with peripheral cup capture, bone graftingwith morsellized femoral head autograft. Cup lateralized toanatomical center• Short stem femoral prosthesis with ceramic on metal bearings• Residual LLD- 1.5cm.Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
  4. 4. • Case 2- 42 year old male, transverse fractureacetabulum with ORIF.• Acetabular reconstruction w/o bone grafting, short stemfemoral and uncemented cup. Ceramic on metalbearings.• No post op LLD.• LLDAbstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
  5. 5. • Case 3-47 year old female, transverse fracture acetabulum withabsorption of femoral head, proximal & central migration withprotrusio acetabuli• THR –Acetabular reconstruction with peripheral cup placement, bonegrafting.• Femoral reconstruction with THR as head was partially resorbed.Metal on poly bearings• No LLD post opAbstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
  6. 6. • Case 4- 30 year old male, posterior wall & roof fracture, proximalfemoral head migration. Pre op LLD of three inches• THR with posterior wall & roof acetabular reconstruction with femoralhead cortico-cancellous slice, Recon plate on acetabular side,conventional uncemented femur. Ceramic on ceramic bearings.• No post op LLD.• Post op sciatic N. palsyAbstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
  7. 7. • Myositis ossificans post op.• Sciatic nerve palsy. Keep knee flexed during surgery.• Limb length discrepancy.• ? Retention / removal of previous metal ware.• Hindrance during acetabular preparation from previous metalware. May need screw cutting rather than removal.• Bone graft required- femoral autograft, cryo allograft,• Synthetic bone substitutes- Hydroxy apatite, Calcium sulphate• Metal restrictors- trabecular metal, Augments, cages. Cementnot preferred as most patients are young.• Acetabular reconstruction with Jumbo cups, cages, augments,restrictors, recon plate, bone graft.Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
  8. 8. • THR has been standard procedure. Uncemented THRpreferred as most patients are young.• When gross LLD is present, due to combination ofacetabular and femoral fractures, total hip replacement isprocedure of choice• If LLD is mainly due to acetabular protrusio and femoralanatomy is preserved, possible to do a short stem hipreplacement.• Hard on hard bearings preferred as most patients areyoung.• Hard on cross linked poly in middle aged.Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
  9. 9. • Previous metal work- can be left alone if Myositis present,Other wise can be removed• Pre op swabs for possible wound infection from previous metalware• Acetabular defects analysed by Paproski classification.Peripheral cup placement in protrusio. Cup should belateralized. Jumbo cup used. Central bone grafting• Peripheral bone grafting in posterior wall and roof fractures.Roof and wall reinforcement with metal & bone prior to hipreplacement.• Possible to use TM augments, but since most patients areyoung, bone graft preferred.• Cup requires screw fixation rather than Mono block cups.Standard or multi hole shells depending on bone loss.Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
  10. 10. • LLD may be present from long standing proximal andcentral migration of proximal femur• Proximal femoral bone loss from AVN, Femoral head &neck bone deficiency due to fracture.• Neck anatomy may be altered precluding short stemprostheses.Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam
  11. 11. • Short stem prosthesis are possible when proximalfemoral anatomy is preserved, minimal LLD( <2”)• Advantage is femoral bone preservation in carefullyselected cases.• Limb length < 1inch can be addressed with variable necklengths in non modular and modular femoral prosthesis.• Versatility of bearing combinations like ceramics, metal,poly.• Femoral side conversion to primary THR in futureeliminating or reducing need for a revision femoralimplant.• Increased cost of short stem prosthesis is a factor.Abstract number 226 E Poster –AP03 Dr.A.K.Venkatachalam